scholarly journals COVID-19 And Erythrocyte Aggregates: An Intensivists Experience When Being Affected

2020 ◽  
Author(s):  
Md Rabiul Alam ◽  
Mahbuba Rehana Raheen
Keyword(s):  
Distress Syndrome ◽  
Chronic Hypoxia ◽  
Healthcare Providers ◽  
Vital Organ ◽  
Severe Dehydration ◽  
Organ Protection ◽  
Pulmonary Tissue ◽  
Target Organs ◽  
Insensible Loss ◽  
Introductory Phase

COVID-19 pandemic has killed over 310,000 individuals as of 17 May 2020. Healthcare providers are profoundly vulnerable to be contaminated instead of taking every single careful step. Although the respiratory tract and the lungs are the target organs some complications may develop even at the introductory phase of this sickness course. Hemoconcentration with raised serum ferritin levels is one of the dangerous conditions that may occur from chronic hypoxia and severe dehydration because of increased insensible loss due to continuous excessive perspirations. Recent posthumous pulmonary tissue studies revealed that the viral infective mechanism, as well as the miniaturized erythrocyte aggregates, are additionally a significant contributing phenomenon to create acute respiratory distress syndrome (ARDS). Hematological issues require to deal proactively alongside other vital organ protection protocols for better outcomes. This article will depict the disease sequence of an intensivist working in a corona unit after being infected by COVID-19.

scholarly journals COVID-19 And Erythrocyte Aggregates: An Intensivists Experience When Being Affected

2020 ◽  
Author(s):  
Md Rabiul Alam ◽  
Mahbuba Rehana Raheen
Keyword(s):  
Distress Syndrome ◽  
Chronic Hypoxia ◽  
Healthcare Providers ◽  
Vital Organ ◽  
Severe Dehydration ◽  
Organ Protection ◽  
Pulmonary Tissue ◽  
Target Organs ◽  
Insensible Loss ◽  
Introductory Phase

COVID-19 pandemic has killed over 310,000 individuals as of 17 May 2020. Healthcare providers are profoundly vulnerable to be contaminated instead of taking every single careful step. Although the respiratory tract and the lungs are the target organs some complications may develop even at the introductory phase of this sickness course. Hemoconcentration with raised serum ferritin levels is one of the dangerous conditions that may occur from chronic hypoxia and severe dehydration because of increased insensible loss due to continuous excessive perspirations. Recent posthumous pulmonary tissue studies revealed that the viral infective mechanism, as well as the miniaturized erythrocyte aggregates, are additionally a significant contributing phenomenon to create acute respiratory distress syndrome (ARDS). Hematological issues require to deal proactively alongside other vital organ protection protocols for better outcomes. This article will depict the disease sequence of an intensivist working in a corona unit after being infected by COVID-19.

scholarly journals Case Report: Disposition of Symptomatic Probable COVID-19

2020 ◽  
Vol 4 (3) ◽  
pp. 336-339
Author(s):  
Aleq Jaffery ◽  
John Slakey ◽  
David Zodda ◽  
Douglas Finefrock
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Distress Syndrome ◽  
Healthcare Providers ◽  
The Novel ◽  
Moderate Risk ◽  
Risk Of Progression ◽  
Novel Coronavirus ◽  
Tools And Techniques

Introduction: The novel coronavirus disease 2019 (COVID-19) presents a challenge for healthcare providers in terms of diagnosis, management, and triage of cases requiring admission. Case Report: A 47-year-old male with symptoms suspicious for COVID-19, pulse oximetry of 93% on room air, and multifocal pneumonia was risk stratified and safely discharged from the emergency department (ED) despite having moderate risk of progression to acute respiratory distress syndrome. He had resolution of his symptoms verified by telephone follow-up. Conclusion: Various risk-stratifying tools and techniques can aid clinicians in identifying COVID-19 patients who can be safely discharged from the ED.

scholarly journals Qualitative study of healthcare providers’ current practice patterns and barriers to successful rehydration for pediatric diarrheal illnesses in Kenya

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3829 ◽  
Author(s):  
Darlene R. House ◽  
Philip Cheptinga ◽  
Daniel E. Rusyniak ◽  
Rachel C. Vreeman
Keyword(s):  
Healthcare Providers ◽  
World Health ◽  
Pediatric Care ◽  
Intravenous Fluids ◽  
Care Providers ◽  
Who Guidelines ◽  
Severe Dehydration ◽  
Western Kenya ◽  
Diarrheal Illness ◽  
Nasogastric Tubes

Background For children worldwide, diarrhea is the second leading cause of death. These deaths are preventable by fluid resuscitation. Nasogastric tubes (NGs) have been shown to be equivalent to intravenous fluids for rehydration and recommended by the World Health Organization (WHO) for use in severe dehydration. Despite this, NGs are rarely used for rehydration in Kenya. Our objective was to evaluate clinicians’ adherence to rehydration guidelines and to identify barriers to the use of NGs for resuscitating dehydrated children. Methods A case-based structured survey was administered to pediatric care providers in western Kenya to determine their choices for alternative rehydration therapies when oral rehydration and intravenous fluids fail. Providers then participated in a qualitative, semi-structured interview to identify barriers to using nasogastric tubes for rehydration. Analysis included manual, progressive coding of interview transcripts to identify emerging central themes. Results Of 44 participants, only four (9%) followed WHO guidelines that recommend quickly switching to NG for rehydration in their case responses. Participants identified that placing intravenous lines in dehydrated children is a challenge. However, when discussing NG use, many believed NGs are not effective for rehydration. Other participants’ concerns surrounded knowledge and training regarding guidelines as well as not having NGs available. Discussion Healthcare providers in western Kenya do not report using NGs for rehydration in accordance with WHO guidelines for diarrheal illness with severe dehydration. Barriers to the use of NG tubes were lack of knowledge and availability. Education and implementation of guidelines using NG tubes for rehydration may improve outcomes of children suffering from diarrheal illness with severe dehydration.

Особливості біохімічного складу сурфактанта легень щурів при гострому респіраторному дистрес-синдромі

2018 ◽  
Author(s):  
V. O. Beskyy ◽  
L. A. Hryshchuk ◽  
A. M. Shumeliak ◽  
M. I. Marushchak
Keyword(s):  
Fatty Acids ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Free Fatty Acids ◽  
Chemical Structure ◽  
Distress Syndrome ◽  
Male Rats ◽  
Tissue Homogenate ◽  
Pulmonary Tissue

Introduction. Despite significant scientific advances in the understanding of the clinical and pathobiochemical aspects of acute respiratory distress syndrome (ARDS), there is no specific therapy. This substantiates the search for new mechanisms of the impact of damaging factors on pulmonary tissue and the body of patients with ARDS.The aim of the study – to analyze the chemical composition of the pulmonary surfactant in the dynamics of acute respiratory distress syndrome in rats.Research Methods. Experiments were conducted on 60 white nonlinear male-rats, which were modulated acute lung injury by intratracheal administration of hydrochloric acid at pH 1.2 at a dose of 1.0 ml/ kg per breath.The content of phospholipids, triacylglycerols, free fatty acids and cholesterol was determined in the pulmonary tissue homogenate. The biochemical study of surfactant phospholipids was performed by thin layer chromatography.Results and Discussion. The results of the study indicate an increase of cholesterol and free fatty acids concentration in the pulmonary homogenate in the dynamics of ARDS. In contrast to the content of cholesterol and free fatty acids in the tissues of the lungs, the concentration of triacylglycerols and phospholipids are decreased. The obtained data indicate that the chemical structure of the surfactant is violated by ARDS, which leads to the decreasingof its functional capacity. Against the background of a marked reduction in the content of phosphatidylcholine, an increase in lysophosphatidylcholine, the percentage of phosphatidylethanolamine, sphingomyelin, phosphatidylinositol and phosphatidylserine increased in a compensatory manner. It should be noted that these values reached their maximum value in 5 research groups, in particular, after 24 hours, the content of phosphatidylethanolamine was higher by 48.4% vs control indicators, respectively, sphingomyelin – by 22.0%, phosphatidylinositol – by 37, 7% and phosphatidylserine – by 35.0%.Conclusions. In case of acute respiratory distress syndrome in rats, the chemical structure of surfactant is altered due to changes in lipid metabolism: cholesterol and free fatty acids had increased, levels of triacylglycerols and total phospholipids had decreased in pulmonary homogenate in the dynamics of the studied pathology. The obtained data indicate a decrease in the surfactant synthesizing capacity of the lungs with respiratory distress syndrome.

scholarly journals Platelet-derived TLT-1 is a prognostic indicator in ALI/ARDS and prevents tissue damage in the lungs in a mouse model

Blood ◽  
2018 ◽  
Vol 132 (23) ◽  
pp. 2495-2505 ◽  
Author(s):  
Jessica Morales-Ortíz ◽  
Victoria Deal ◽  
Fiorella Reyes ◽  
Gerónimo Maldonado-Martínez ◽  
Nahomy Ledesma ◽  
...  
Keyword(s):  
Tissue Damage ◽  
Distress Syndrome ◽  
Pulmonary Hemorrhage ◽  
Prognostic Indicator ◽  
Wild Type ◽  
Exact Role ◽  
Pulmonary Tissue ◽  
Leukocyte Transmigration ◽  
Fibrinogen Deposition

Abstract Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) affect >200 000 individuals yearly with a 40% mortality rate. Although platelets are implicated in the progression of ALI/ARDS, their exact role remains undefined. Triggering receptor expressed in myeloid cells (TREM)–like transcript 1 (TLT-1) is found on platelets, binds fibrinogen, and mediates clot formation. We hypothesized that platelets use TLT-1 to manage the progression of ALI/ARDS. Here we retrospectively measure plasma levels of soluble TLT-1 (sTLT-1) from the ARDS Network clinical trial and show that patients whose sTLT-1 levels were >1200 pg/mL had nearly twice the mortality risk as those with <1200 pg/mL (P < .001). After correcting for confounding factors such as creatinine levels, Acute Physiology And Chronic Health Evaluation III scores, age, platelet counts, and ventilation volume, sTLT-1 remains significant, suggesting that sTLT-1 is an independent prognostic factor (P < .0001). These data point to a role for TLT-1 during the progression of ALI/ARDS. We use a murine lipopolysaccharide-induced ALI model and demonstrate increased alveolar bleeding, aberrant neutrophil transmigration and accumulation associated with decreased fibrinogen deposition, and increased pulmonary tissue damage in the absence of TLT-1. The loss of TLT-1 resulted in an increased proportion of platelet-neutrophil conjugates (43.73 ± 24.75% vs 8.92 ± 2.4% in wild-type mice), which correlated with increased neutrophil death. Infusion of sTLT-1 restores normal fibrinogen deposition and reduces pulmonary hemorrhage by 40% (P ≤ .001) and tissue damage by 25% (P ≤ .001) in vivo. Our findings suggest that TLT-1 uses fibrinogen to govern the transition between inflammation and hemostasis and facilitate controlled leukocyte transmigration during the progression of ARDS.

The Ethics of Organ Donation after Cardiac Death

2020 ◽  
Vol 20 (4) ◽  
pp. 745-758
Author(s):  
Matthew T. Warnez ◽  
Keyword(s):  
United States ◽  
Cardiac Death ◽  
The United States ◽  
Donation After Cardiac Death ◽  
Vital Organ ◽  
Ethical Problems ◽  
Moral Tradition ◽  
Target Organs ◽  
Organ Donations ◽  
Circulatory Death

Organ donations after cardiac death account for about 20 percent of all vital-organ transplantations in the United States. This article evaluates DCDs in light of the Catholic moral tradition. Certain premortem interventions commonly associated with DCDs (intended to protect target organs from asystolic deterioration) are morally impermissible even though the injuries they inflict on the patient are ostensibly inconsequential. More importantly, the criteria used for expeditiously assaying circulatory death—criteria which enhance the effectiveness of DCDs—do not always guarantee that the donor is actually deceased. Unless DCD protocols attend to these ethical problems, Catholic hospitals are obliged to abandon the practice.

scholarly journals Targeting MMP-Regulation of Inflammation to Increase Metabolic Tolerance to COVID-19 Pathologies: A Hypothesis

Biomolecules ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 390
Author(s):  
Eugenio Hardy ◽  
Carlos Fernandez-Patron
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Energy Metabolism ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Multiorgan Failure ◽  
Target Organ ◽  
Therapeutic Approaches ◽  
Target Organs

Many individuals infected with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) develop no or only mild symptoms, but some can go on onto develop a spectrum of pathologies including pneumonia, acute respiratory distress syndrome, respiratory failure, systemic inflammation, and multiorgan failure. Many pathogens, viral and non-viral, can elicit these pathologies, which justifies reconsidering whether the target of therapeutic approaches to fight pathogen infections should be (a) the pathogen itself, (b) the pathologies elicited by the pathogen interaction with the human host, or (c) a combination of both. While little is known about the immunopathology of SARS-CoV-2, it is well-established that the above-mentioned pathologies are associated with hyper-inflammation, tissue damage, and the perturbation of target organ metabolism. Mounting evidence has shown that these processes are regulated by endoproteinases (particularly, matrix metalloproteinases (MMPs)). Here, we review what is known about the roles played by MMPs in the development of COVID-19 and postulate a mechanism by which MMPs could influence energy metabolism in target organs, such as the lung. Finally, we discuss the suitability of MMPs as therapeutic targets to increase the metabolic tolerance of the host to damage inflicted by the pathogen infection, with a focus on SARS-CoV-2.

scholarly journals COVID-19 Infection

2020 ◽  
Vol 132 (6) ◽  
pp. 1346-1361 ◽  
Author(s):  
John R. Greenland ◽  
Marilyn D. Michelow ◽  
Linlin Wang ◽  
Martin J. London
Keyword(s):  
Respiratory Failure ◽  
Care Management ◽  
Distress Syndrome ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Health Organizations ◽  
Hypoxemic Respiratory Failure ◽  
Major Health ◽  
Intensive Care Management ◽  
Potential Therapeutics

Abstract Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19–associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.

Sites of Insulin Action Using Ferritin Labeling

1971 ◽  
Vol 29 ◽  
pp. 540-541
Author(s):  
Burton B. Silver ◽  
Ronald S. Nelson
Keyword(s):  
Electron Microscopy ◽  
Binding Sites ◽  
Anterior Pituitary ◽  
Insulin Action ◽  
Diabetic Rats ◽  
Insulin Antibody ◽  
Fat Pad ◽  
Target Organs ◽  
Uranium Salts ◽  
Sugar Levels

Some investigators feel that insulin does not enter cells but exerts its influence in some manner on the cell surface. Ferritin labeling of insulin and insulin antibody was used to determine if binding sites of insulin to specific target organs could be seen with electron microscopy.Alloxanized rats were considered diabetic if blood sugar levels were in excess of 300 mg %. Test reagents included ferritin, ferritin labeled insulin, and ferritin labeled insulin antibody. Target organs examined were were diaphragm, kidney, gastrocnemius, fat pad, liver and anterior pituitary. Reagents were administered through the left common carotid. Survival time was at least one hour in test animals. Tissue incubation studies were also done in normal as well as diabetic rats. Specimens were fixed in gluteraldehyde and osmium followed by staining with lead and uranium salts. Some tissues were not stained.

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